Intra- and post-procedural patient-reported experience measures and their correlation with post-ERCP adverse events and unplanned healthcare utilization

Background Post-endoscopic retrograde cholangiopancreatography (ERCP) adverse events (AEs) are common, as is unplanned healthcare utilization (UHU). We aimed to assess potential etiologic associations between intra-/post-procedural patient-reported experience measures (PREMs) and post-ERCP AEs and UHU. 

Methods Prospective data from a multicenter collaborative were used. A 0-10 Likert-based PREM assessing intra-and post-procedural symptoms was applied to patients following ERCP, and follow-up was performed at 30 days to identify AEs and UHU for reasons not meeting the definitions of any AE. Multivariable logistic regression was conducted using PREM domains as exposures and AEs and UHU as outcomes, with a priori selected covariates. Odds ratios (ORs) and 95%CIs for each PREM domain were reported. Results From 2018 to 2023, 3434 patients were included. A post-procedural abdominal pain score >3 was associated with pancreatitis (OR 3.71 [95%CI 2.37-5.73]), while a score >6 was associated with perforation (OR 9.54 [95%CI 1.10-59.37]). Post-procedural pain was also associated with UHU within 30 days when used as a continuous exposure (OR 1.08 per point [95%CI 1.01-1.16]), and when partitioned at a score >3 (OR 1.79 [95%CI 1.13-2.74]) and a score >6 (OR 1.93 [95%CI 1.02-3.46]). No other intra- or post-procedural PREMs were associated with any AEs or UHU. Conclusions Patient-reported abdominal pain from a Likert-based PREM at the time of discharge from ERCP was associated with pancreatitis, perforation, and UHU within 30 days. Applying PREMs could potentially prevent UHU and/or facilitate earlier management and improved outcomes for patients with post-ERCP AEs.